This questionnaire should be filled out by a Sub and provided to their Dom/Top before playing with them.

This
will provide a quick "head-start" to identifying limits, negotiating and finding common ground for play.

There is intentionally some overlap between categories. Unless otherwise stated, the Sub is the recipient of the
activity.

For each item, you need to provide two answers:

1. First write YES or NO next to each item to indicate if you have ever DONE that activity. Mark N/A if it
does not apply to your gender.
2. Indicate for each item how you FEEL about that activity by rating it on a scale of NO or 0 to 5.
 NO - you will NOT do that item under any circumstances (a hard limit).
 0 (zero) - indicates you have utterly no desire to do that activity and don't like doing it (in fact, may loath
it) and would ordinarily object to doing it, but you would be willing to do it to please the Dominant if it
they really wanted it. (sometimes called a "soft limit").
 1 - you don't want to do or like to do this activity, but wouldn't object if it was asked of you.
 2 - you are willing to do this activity, but it has no special appeal for you.
 3 - you usually like doing this activity, at least on an irregular/ occasional basis.
 4 - you like doing this activity, and would like to experience it on a regular basis.
 5 - the activity is a wild turn-on for you, and you would like it as often as possible.
3. Mark with an asterisk (*) those items which you are willing to do only with your current sex partner(s), but
not with casual play partners.
4. Note any additional information that might be important for your Dom to know in the comments box.
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Abrasion
Age Play
Anal Sex
Anal plugs (small)
Anal plugs (large)
Anal plug
(public, under clothes)
Animal roles
Arm & leg sleeves
(arm binders)
Asphyxiation
Auctioned for charity
Bathroom use control
Beastiality
Beating (soft)
Beating (hard)
Blindfolds
Being serviced (sexual)
Being bitten
Breast/chest bondage
Breath control
Branding
Boot worship
Bondage
Hands in Front
Hands Behind
Hands over head
Ankles
Knees
Elbows
Wrist-to-ankles
Wrist-to-waist
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Spreader Bars
Tied to a Chair
Tied to a Bed
Using Rope
Using Tape
Metal Cuffs
Leather Cuffs
Silk ties

Bondage (multi-day)
Bondage
(public, under clothing)
Breast whipping
Brown showers (scat)
Cages (locked inside of)
Caning
Catheterization
Cells/Closets
(locked inside of)
Chastity belts
Chauffeuring
Choking
Clamps
Nipples
Genital
Other
Clothespins
Cock worship
Collars (worn in private)
Collars (worn in public)
Competitions
(with other Subs)
Corsets (wearing)
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Cunnilingus
Dilation
Double penetration
Electricity
Enemas
Enforced chastity
Examinations (physical)
Exercise (forced/required)
Exhibitionism (friends)
Exhibitionism (strangers)
Eye contact restrictions
Face slapping
Fantasy abandonment
Fantasy rape
Fantasy gang-rape
Fisting (anal)
Fisting (vaginal)
Following orders
Foot worship
Forced dressing
Forced homosexuality
Forced masturbation
Forced nudity (private)
Forced nudity
(around others)
Forced servitude
Full head hoods
Gags (cloth)
Gags (rubber)
Gags (tape)
Gates of Hell (male)
Genital sex
Given away to another Dom
(temporary)
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Given away to another Dom
(permanent)
Golden showers
Hairbrush spankings
Hair pulling
Hand jobs (giving)
Hand jobs (receiving)
Harems
(serving w/other subs)
Harnessing (leather)
Harnessing (rope)
Having food chosen for you
Having clothing chosen for
you
Head (giving fellatio)
Head (receiving fellatio)
High heel worship
Homage with tongue
(non-sexual)
Hot oils (on genitals)
Hot waxing
Housework (doing)
Human puppy dog
Humiliation (private)
Humiliation (public)
Hypnotism
Ice cubes
Infantilism
Initiation rites
Injections
Intricate (Japanese) rope
bondage
Interrogations
Kidnapping
Kneeling
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Leather clothing
Leather restraints
Lectures for misbehavior
Licking (non-sexual)
Manacles & Irons
Manicures (giving)
Marks
Visible in street clothes
Visible in bathing suit
Massage (giving)
Massage (receiving)
Medical scenes
Modeling for erotic photos
Mouth bits
Mummification
Nipple weights
Oral/anal play (rimming)
Over-the-knee spanking
Orgasm denial
Orgasm control
Outdoor scenes
Outdoor sex:
Phone sex (serving Dom)
Phone sex
(serving Dom's friends)
Piercing
(temporary, play-pierce)
Piercing (permanent)
Prison scenes
Pony slave
Public exposure
Pussy/cock whipping
Pussy worship
Riding crops
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Riding the "horse"
(crotch torture)
Rituals
Religious scenes
Restrictive rules on behavior
Rubber/latex clothing
Rope body harness
Saran wrapping
Scratching - getting
Scratching - giving:
Sensory deprivation
Serving
Serving as art
Serving as ashtray
Serving as furniture
Serving as a maid:
Serving as toilet
Serving as waitress/waiter
Serving orally (sexual)
Serving other doms
(supervised)
Serving other doms
(unsupervised)
Sexual deprivation
(short term)
Sexual deprivation
(long term)
Shaving (body hair)
Shaving (head hair)
Sleep deprivation
Sleep sacks
Slutty clothing (private)
Slutty clothing (public)
Spanking
Spandex clothing
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Speech restrictions
(when, what)
Speculums (Anal)
Speculums (vaginal)
Standing in corner
Stocks
Straight jackets
Strap-on-dildos (sucking on)
Strap-on-dildos
(penetrated by)
Strap-on-dildos (wearing)
Strapping (full body beating)
Suspension (upright)
Suspension (inverted)
Suspension (horizontal)
Supplying new partners for
Dom
Swallowing semen
Swallowing urine
Swapping
(with one other couple)
Swinging (multiple couples)
Tattooing
Teasing
Tickling
Triple penetration
Uniforms
Including others
Vaginal dildo
Verbal humiliation
Vibrator on genitals
Voyeurism (watching others)
Voyeurism
(your Dom w/others)
Video (watching others)
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Video (recordings of you)
Water torture
Wearing symbolic jewelry
Whipping
Wooden paddles
Wrestling